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Appendix B
Exposure Measures in Studies of U.S. Vietnam Veterans
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TABLE B-1 Exposure Measures in Studies of U.S. Vietnam Veterans
Reference
Design
Description
Sources of Exposure Data
Exposure Measures
CDC Studies
Erickson et al., 1984a,b
Case-control
CDC Birth Defects Study
Birth defect cases and normal controls born in the Atlanta, GA, area, 1968–1980
Telephone interview
Military records
Veteran (ever served in U.S. military)
Vietnam service before conception of case/control offspring
EOI (values 1–5): scores assigned on the basis of reviews by Army experts of duties, dates, and places of service in Vietnam; separate scores for information from (1) interviews and (2) review of military records
Self-reports of Agent Orange exposure
Boyle et al., 1987; CDC, 1987
Retrospective cohort
CDC Vietnam Experience Study: Mortality in Vietnam and Vietnam-era veterans
Military records
Army service in Vietnam between 1965 and 1971
CDC, 1988a,b,c, 1989
Cohort
CDC Vietnam Experience Study: Psychosocial, physical health, and reproductive outcomes
Military records
Telephone interview
Army service in Vietnam between 1965 and 1971
Self-reported exposures
CDC, 1988d
Cohort pilot
CDC Agent Orange Validation Study
Army Vietnam veterans and Vietnam-era controls
Military records
Self-report through structured interview
Five scores based on military records; two scores based on information from self-report
The scoring methods based on information from military records reflected different assumptions about TCDD half-life and about completeness of data on troop and herbicide spray locations
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Two other scores were based on information from the structured interview (self-report): number of days of direct exposure to herbicides during military service; and number of days of indirect exposure to herbicides during military service
CDC, 1990a,b,c,d
Case-control
Selected Cancer Studies:
Studies of NHL, HD, STS, nasal carcinoma, nasopharyngeal carcinoma, liver cancer
Telephone interview, supplemented by review of military records
Classification of unit mission by U.S. Army ESG
Self-reported Vietnam service (in sensitivity analyses, service in Vietnam distinguished from service off the coast)
Considered branch of service, unit, location in Vietnam, job duties, tour of duty, rank, perceived exposure to herbicides
Non-Vietnam occupational exposure to phenoxy herbicides
O’Brien et al., 1991
Cohort
NHL cases identified within Vietnam Experience Study cohort
Military records
Interview
Vietnam service, noting region of service and military occupation
Decouflé et al., 1992
Cohort
Vietnam Experience Study
Relationship of self-reported health to self-reported exposure to herbicides and combat among Army veterans
Military records
Telephone questionnaire
Herbicide exposure index reflecting four categories of increasing intensity of exposure based on self-report
Boehmer et al., 2004
Cohort
Mortality update of Vietnam Experience Study cohort
Military records
Entered military service 1965–1971, at least one tour of Army service in Vietnam
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Reference
Design
Description
Sources of Exposure Data
Exposure Measures
Department of Veterans Affairs Studies
Kang et al., 1986
Case-control
Hospital-based study of Vietnam and Vietnam-era veterans diagnosed with STS, 1969–1983
Military records
Vietnam service
Burt et al., 1987
Retrospective cohort
NHL mortality among Vietnam and Vietnam-era Army and Marine Corps veterans
Military records
Service as a member of Army or Marine Corps in Vietnam between July 4, 1965, and March 1, 1973
Kang et al., 1987
Case-control
STS cases diagnosed at Armed Forces Institute of Pathology (1975–1980); controls from patient logs of referring pathologists
Military records
Telephone interview
Vietnam service in Army or Marine Corps, combat-related military occupation, and broad geographic location of individual’s unit at time of service
Breslin et al., 1988
Retrospective cohort
Mortality among Vietnam and Vietnam-era Army and Marine Corps veterans
Military records
Service as a member of Army or Marine Corps in Vietnam between July 4, 1965, and March 1, 1973
True et al., 1988
Cross-sectional
Military service in Vietnam and subsequent posttraumatic stress disorder symptoms
Questionnaire
Exposure to combat in Vietnam
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Bullman et al., 1990
Cohort
Mortality in Army Vietnam and Vietnam-era veterans who served in Military Region I
Military records
Service in Military Region I
Farberow et al., 1990
Case-control
Suicide and motor vehicle deaths in Los Angeles County among Vietnam and Vietnam-era Army and Marine Corps veterans
Military records
Medical examiner’s records
Next-of-kin interviews
Vietnam service, combat-related military occupation based on military records; aspects of military experience based on next-of-kin report
Goldberg et al., 1990
Cohort
Posttraumatic stress disorder among monozygotic twin pairs serving in the military during the Vietnam era
Military records
Questionnaire
Southeast Asia service
Bullman et al., 1991
Case-control
Combat and other service experience in posttraumatic stress disorder cases and controls selected from the VA Agent Orange Registry
Military records
Vietnam service in a combat-related military occupation, having been wounded in Vietnam, having been awarded medals for combat-related Vietnam service
Dalager et al., 1991
Case-control
Vietnam and Vietnam-era veterans diagnosed with NHL in VA hospitals, 1969–1985
Military records
Branch of service, combat role, service within a specific region in Vietnam, extended service in Vietnam
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Reference
Design
Description
Sources of Exposure Data
Exposure Measures
Eisen et al., 1991
Cohort
Health status of monozygotic twin pairs who served in the military during the Vietnam era
Mail survey or telephone interviews
Southeast Asia service
Thomas et al., 1991
Cohort
Mortality in women Vietnam veterans and Vietnam-era veterans deceased 1973–1987
Military records
Vietnam service
Watanabe et al., 1991
Retrospective cohort
Follow-up through 1984 of mortality study by Breslin et al., 1988
Military records
Army or Marine Corps service in Vietnam between July 4, 1965, and March 1, 1973
Bullman et al., 1994
Case-control
Testicular cancer cases and controls identified from VA Agent Orange Registry
Military records
Branch of service, type of duty, corps area, and location of individual’s unit in relation to recorded Agent Orange spray tracks
Dalager et al., 1995a
Cohort
Mortality study of women Vietnam veterans and Vietnam-era veterans who died 1965–1992
Update of Thomas et al., 1991
Military records
Vietnam service
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Dalager et al., 1995b
Case-control
Vietnam and Vietnam-era veterans diagnosed with Hodgkin’s disease in VA hospitals, 1969–1985
Military records
Branch of service, combat role, service within a specific region in Vietnam, extended service in Vietnam
Watanabe and Kang, 1995
Cohort
Mortality study of U.S. Marine Vietnam and Vietnam-era veterans
Extension of Breslin et al., 1988, and Watanabe et al., 1991
Military records
Vietnam service
Watanabe and Kang, 1996
Cohort
Mortality study of Army and Marine Corps Vietnam and Vietnam-era veterans who died 1965–1988
Military records
Vietnam service
Mahan et al., 1997
Case-control
Lung cancer cases among Vietnam-era veterans
Military records
Vietnam service
Location of service member’s unit in relation to areas sprayed with herbicides and time elapsed since spraying
McKinney et al., 1997
Cross-sectional
Smoking patterns among veterans and non-veterans
1987 National Medical Expenditure Survey
Vietnam service
Kang et al., 2000a
Cohort
Self-reported pregnancy outcomes for women Vietnam and Vietnam-era veterans
Military records
Structured telephone interview
Vietnam service
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Reference
Design
Description
Sources of Exposure Data
Exposure Measures
Kang et al., 2000b
Cohort
Gynecologic cancers among women Vietnam and Vietnam-era veterans
Military records
Structured telephone interview
Vietnam service
State Studies
Greenwald et al., 1984
Case-control
STS cases from New York State Cancer Registry, diagnosed 1962–1980; population controls
Interview of study subjects or next of kin
Self- or proxy report of Vietnam service, exposure to Agent Orange
Newell, 1984
Cross-sectional
Pilot analyses of cytogenetics, sperm evaluation, and immune response in Vietnam veterans from Texas
Military records
Questionnaire
Exposure to herbicides based on the amount of herbicide sprayed in the area where the individual served during period of service
Reported presence of chloracne
Kogan and Clapp, 1985
Cohort
Mortality study of Massachusetts Vietnam and Vietnam-era veterans, deceased 1972–1983
List of Massachusetts veterans who served between 1958 and 1973 and received a bonus
Vietnam service
Lawrence et al., 1985
Cohort
Mortality study of veterans discharged from service 1971–1973 and deceased in New York through 1980
Military records (Vietnam service indicators in DMDC roster)
Vietnam service
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Rellahan, 1985
Cohort
Survey of residents of Oahu, Hawaii, with Vietnam-era military service
Questionnaire
Vietnam service
Wendt, 1985
Descriptive
Survey of Iowa Vietnam and Vietnam-era veterans
Iowa Department of Veterans Affairs records
Questionnaire
Self-reported spraying or handling of Agent Orange, or passing through a sprayed area
Anderson et al., 1986
Cohort
Mortality study of Wisconsin Vietnam veterans, Vietnam-era veterans, and non-veterans
Military records
Vietnam service
Goun and Kuller, 1986
Case-control
Mortality from STS, NHL, and other cancers among Pennsylvania male Vietnam veterans
Federal military records
Commonwealth of Pennsylvania Department of Military Affairs records
Vietnam service
Holmes et al., 1986
Cohort
Mortality study of West Virginia Vietnam veterans
List of recipients of West Virginia Vietnam-era service bonus
Vietnam service
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Reference
Design
Description
Sources of Exposure Data
Exposure Measures
Pollei et al., 1986
Case-control
Chest radiographs of Vietnam veteransin Albuquerque VA Agent Orange registry; compared to Air Force personnel with no Vietnam service
Interviews; some military records
Registry enrollment; self-reported repeated exposure to Agent Orange
Kahn et al., 1988
Pilot exposure study
Herbicide exposure study of Vietnam and Vietnam-era veterans
Self report, validated with examination of military records by U.S. Army ESG
Highly exposed to Agent Orange (by job title and self-report)
Adipose tissue and blood serum measurement of TCDD
Kogan and Clapp, 1988
Cohort
Mortality study of Massachusetts Vietnam and Vietnam-era veterans, deceased 1972–1983; focus on cancer mortality
List of Massachusetts veterans who served between 1958 and 1973 and received a bonus
Vietnam service
Levy, 1988
Cross-sectional
PTSD in those with chloracne among a subset of Massachusetts Vietnam bonus recipients
Telephone interview
Medical examination
Current diagnosis of chloracne
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Clapp et al., 1991
Case-control
Cancer cases from Massachusetts Cancer Registry, diagnosed 1982–1988
List of Massachusetts veterans who served between 1958 and 1973 and received a bonus
Vietnam service
Deprez et al., 1991
Descriptive
Health status and reproductive outcomes in Maine Vietnam veterans
Questionnaire
Self-reported exposure to herbicides
Fiedler et al., 1992; Kahn et al., 1992a,b
Cohort
Health outcomes in New Jersey Vietnam and Vietnam-era veterans
Self report, validated with examination of military records by U.S. Army ESG
TCDD in blood; service in units that operated in heavily sprayed areas of Vietnam
Visintainer et al., 1995
Cohort
Mortality study of Michigan Vietnam and Vietnam-era veterans
Michigan bonus list
Vietnam service (“in-country” versus “out-country”)
Clapp, 1997
Case-control
Cancer cases from Massachusetts Cancer Registry, diagnosed 1982–1993
Update of Clapp et al., 1991
List of Massachusetts veterans who served between 1958 and 1973 and received a bonus
Vietnam service
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Reference
Design
Description
Sources of Exposure Data
Exposure Measures
American Legion Studies
Snow et al., 1988
Cohort
Health and reproductive outcomes among American Legion members who served in Vietnam, examining combat and herbicide exposures
Questionnaire
Scale of combat intensity based on self-report
Stellman et al., 1988a
Cohort
Social and behavioral outcomes among American Legion members who served in Vietnam, examining combat and herbicide exposures
Questionnaire
Separate exposure opportunity indexes for Agent Orange and for all herbicides, based on 1986 proximity model using HERBS and Services HERBS tapes and point locations for centers of major troop activity
Stellman et al., 1988b
Cohort
Health and reproductive outcomes among American Legion members who served in Vietnam, examining combat and herbicide exposures
Questionnaire
Separate exposure opportunity indexes for Agent Orange and for all herbicides, based on 1986 proximity model using HERBS and Services HERBS tapes and point locations for centers of major troop activity
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Other Studies of Vietnam Veterans
Aschengrau and Monson, 1989
Case-control
Paternal Vietnam service and risk of spontaneous abortion
Federal military records
Massachusetts Vietnam bonus list
Vietnam service
Aschengrau and Monson, 1990
Case-control
Paternal Vietnam service and risk of late adverse pregnancy outcomes
Federal military records
Massachusetts Vietnam bonus list
Vietnam service
Tarone et al., 1991
Case-control
Vietnam veterans with testicular cancer and hospital controls with other cancers
Questionnaire
Vietnam service
NOTES: Excludes studies of the Air Force Health Study (Ranch Hand) and Army Chemical Corps cohorts. CDC, Centers for Disease Control and Prevention; DMDC, Defense Manpower Data Center; EOI, exposure opportunity index; ESG, U.S. Army and Joint Services Environmental Support Group; NHL, non-Hodgkin’s lymphoma; PTSD, posttraumatic stress disorder; STS, soft-tissue sarcoma; TCDD, 2,3,7,8-tetrachlorodibenzo-p-dioxin.
SOURCE: Adapted from Table C-3 (IOM, 2007).
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